Quality Improvement Organ

Quality Improvement Survey Organ

The Arkansas Regional Organ Recovery Agency appreciates your input and involvement with us in the donation process. Your perceptions are important to us in maintaining quality service. Your comments will also help us to meet your needs. Please complete the following questionnaire.

Date: *

Donor Name *

ARORA Referral Number

Your Name (Optional)

Hospital *

Hospital Unit *

Email Address (Optional)

Did the ARORA Personnel: *

	Yes	No	Not Obsereved
Respond to your initial telephone referral in a timely manner?	Yes	No	Not Obsereved
Arrive at the hospital in a satisfactory amount of time?	Yes	No	Not Obsereved
Conduct themselves in a professional manner?	Yes	No	Not Obsereved
Introduce other coordinators, surgeons, and assistants as appropriate?	Yes	No	Not Obsereved
Treat the Donor with respect?	Yes	No	Not Obsereved
Assist with procedures at the bedside?	Yes	No	Not Obsereved
Communicate clearly?	Yes	No	Not Obsereved

Please rate the following aspects of our service. *

	Very Good	Good	Fair	Bad	Very Bad
Overall appraisal of the donation process?	Very Good	Good	Fair	Bad	Very Bad
Was the donation process efficient and coordinated?	Very Good	Good	Fair	Bad	Very Bad

Could the Organ Donation Process be Improved? *

Yes

No

If yes, please explain:

0/255 characters

Additional Comments

Suggestions for improvement in services: